Little, Akin-Little, and Gutierrez (2009) emphasize the need for school psychologist to acquire training on meeting the needs of children and adolescents who have experienced trauma. Trauma-Focused Cognitive Behavior Therapy (TF-CBT) is one of three interventions that is empirically supported within the trauma field. Most research has supported the effectiveness of TF-CBT among sexually abused children, as well as other types of trauma (i.e., natural disaster); (Little, Akin-Little, & Gutierrez, 2009).
Sigel and Silovsky (2011) examined a study consisting of pre-doctoral psychology internship training practices that implement empirically supported treatments (EST) for children and their families with a history of maltreatment. This study consisted of an online survey of 137 pre-doctoral psychology internship sites, in which 110 reported implementing at least one EST in their training program. Of the 110 internship sites, 85 were accredited by the APA and only 74 offered training in child maltreatment (Sigel & Silovsky, 2011, p. 240). “The required methods of training in child maltreatment were supervision of clinical services in 98 sites (89%), didactic lectures in 80 (73%), seminars in 59 (54%), workshops in 27 (25%), graduate courses/classes in 2 (2%), and 11 (10%) reported other training methods (e.g., consultation, readings, journal club, online trainings).” (Sigel & Silovsky, 2011, p. 204). The most prevalent treatment taught at these internship sites was TF-CBT, with the second most prevalent treatment being behavioral parent training, including parent-child interaction therapy (PCIT) (Sigel & Silovsky, 2011).
Evidence-based practices (EBP) were reviewed as empirically supported components in combination with cognitive behavior therapy in treating childhood sexual abuse (CSA) (Czincz & Romano, 2013). According to (Czincz & Romano, 2013), only five percent of psychologists in Ontario, Canada were trained in using EBP when looking at cognitive behavioral therapy and CSA. The results of this indicate ethical concerns in psychologists that are currently practicing, and not properly trained to handle trauma-focused cognitive behavior therapy when working with this population (Czincz & Romano, 2013).
According to Viezel and Davis (2015), school psychologists must be experts in child maltreatment, as they may be the only mental health professionals in close proximity who are able to recognize the signs of maltreatment. School psychologists are encouraged to be familiar with prevention and intervention techniques as they are the second most common group of professionals to make reports of instances in which child maltreatment is suspected (Viezel & Davis, 2015). “Doctoral programs in clinical, counseling, and school psychology often fail to meet child maltreatment training standards, even when these issues are addressed in their curricula (Champion, Shipman, Bonner, Hensley, & Howe, 2003). On a recent questionnaire completed by over 200 practicing school psychologists, the most commonly reported ethical dilemma faced in the past year was whether or not to contact CPS when child abuse was suspected, despite the fact that 90% of respondents had at least some formal ethics training (Dailor & Jacob, 2011).” (Viezel & Davis, 2015, p. 4).
Walkley and Cox (2013) examined the impact of trauma on development, as well as the promise of trauma informed schools. Implementing trauma-informed approaches to school settings may assist in improving the emotional and physical safety of students.
Walkley and Cox (2013) focus on childhood stress on a continuum, from normal to traumatic. Near the trauma end of the continuum, Walkley and Cox (2013) use the term “toxic stress” to refer to emotional stress that affects brain development, as well as other aspects of a child’s health. Toxic stress is experienced when a child is frequently exposed to adversity (i.e., child living with drug-addicted parents, or experiencing maltreatment). In school settings, it is important for school staff to acknowledged that children affected by trauma are often mislabeled with attention deficit disorder, conduct disorder, and oppositional-defiant disorder, among other diagnoses (Walkley & Cox, 2013). Walkley and Cox (2013) emphasized the important of creating more trauma responsive-systems in school settings. However, adopting a trauma-informed approach is challenging, as it requires full support, time, and commitment from school principals. A principal named Jim Sporleder from Lincoln High School in Walla Walla, Washington used the trauma-informed approach from 2010-2011. Trauma-informed approach showed a significant reduction in suspensions, expulsions and written referrals. For example, suspensions dropped from 798 to 135 (85%) (Walkley & Cox, 2013, p. 125).
The Child Adult Relationship Enhancement (CARE) program is an evidenced based informed program that consists of a set of skills, which help improve interactions between adults and child or adolescents (Gurwitch et al., 2016).
Although CARE is not therapy, it was developed to assist non-mental health professionals who were seeking training similar to Parent-Child Interaction Therapy (PCIT). CARE was designed as a prevention model for children who may be at risk for maltreatment, or as a compliment to ongoing therapy services. CARE skills may be used by any adult interacting with children and adolescents from the ages of 2 to 18. CARE training does not address extreme disruptive behavior or aggression, which may require a therapeutic intervention. CARE training was designed as more of a prevention model for children at risk for maltreatment or other behavioral concerns (Gurwitch et al., 2016).